FILING FOR DISSOLUTION (D - Oregon Courts Home · 2020-04-17 · Page 2 of 14 . TABLE OF FORMS 1. Starting your Case (See the last box of this table for additional forms you may need)

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FILING FOR DISSOLUTION (DIVORCE)

Notice about these instructions and forms These instructions are not a complete statement of the law. They cover basic procedures for simple dissolution cases with no children under 21. If you have complicated issues or questions about the law, talk to a lawyer.

All of the necessary forms should be online. If you cannot find a form, ask your local court.

Each court has local rules, programs, and procedures that may not be explained in these instructions. Refer to the Supplementary Local Rules for your county. These rules are available online or at your local court or law library. Forms and information about your local court are on the Oregon Judicial Department website.

Important Note

STOP! You may not be able to use this form

Caution! You may need a lawyer

Concerns money

Timing requirement

Important Contact Information Oregon Judicial Department – www.courts.oregon.gov Oregon State Bar Lawyer Referral Service - www.oregonstatebar.org

Phone: 503.684.3763 or toll-free in Oregon at 800.452.7636

If you are deployed or about to be deployed, contact the Oregon State Bar Military Assistance Panel (www.osbar.org/_docs/ris/militaryflier.pdf) for information about special rights and rules that may apply to you.

Symbols used in this form:

(Aug 2019)

http://www.courts.oregon.gov/

http://www.oregonstatebar.org/

http://www.osbar.org/_docs/ris/militaryflier.pdf

http://www.osbar.org/_docs/ris/militaryflier.pdf

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TABLE OF FORMS

1. Starting your Case (See the last box of this table for additional forms you may need)

Guide and File prepared these forms for you: _x__ Petition for Dissolution of Marriage/RDP _x__ Record of Dissolution of Marriage, Annulment or Registered Domestic Partnership _x__ Confidential Information Form (CIF) (one for each party) _x__ Notice of CIF Filing

All other forms in this table are included in this Next Steps document or can be found online at www.courts.oregon.gov/forms

___ Summons ___ Notice of Statutory Restraining Order Preventing Dissipation of Assets

Optional: ___ Fee Deferral or Waiver Application and Declaration

2. Notifying the Other Party

___ Acceptance of Service (if possible) ___ Certificate of Service

3. Temporary Orders

4. Resolving Your Case

By Agreement: ___ Declaration in Support of Judgment ___ General Judgment of Dissolution of Marriage/RDP Or By Default: ___ Ex Parte Motion for Order of Default and Declaration in Support ___ Order on Motion for Default ___ Declaration in Support of Judgment ___ General Judgment of Dissolution of Marriage/RDP Or By Hearing: ___ General Judgment of Dissolution of Marriage/RDP

Additional forms you may need: You may have completed these forms through Guide and File. If you did not, you can find them online at www.courts.oregon.gov/forms

___ Uniform Support Declaration ___ Statement of Assets and Liabilities ___ Waiver of Personal Service ___ End-of-case Fee Waiver Application & Declaration

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http://www.courts.oregon.gov/forms


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Table of Contents

STEP 1: STARTING YOUR CASE ............................................................................................................... 4

Information about Dissolution ............................................................................................................. 4

Statutory Restraining Order ..................................................................................................................... 4

STEP 2: FILING AND SERVICE ................................................................................................................ 4

SERVICE ....................................................................................................................................................... 5 Acceptance of Service ............................................................................................................................... 5 Formal Service ........................................................................................................................................... 6

STEP 3: TEMPORARY ORDERS ............................................................................................................... 8

Domestic Violence .................................................................................................................................... 8

STEP 4: RESOLVING YOUR CASE ........................................................................................................... 9

By Agreement .......................................................................................................................................... 9

By Default ................................................................................................................................................ 9

By Trial …………………………………………………………………………………………………………………………………………… 10

THE JUDGMENT ...................................................................................................................................... 11

Additional Forms:

Notice of Statutory Restraining Order Preventing the Dissipation of Assets in DomesticRelations Actions

Notice to Parties in a Suit for Marriage Dissolution or Legal Separation RegardingContinuation of Health Coverage (COBRA Notice)

Summons for Family Law Case

Acceptance of Service

Certificate of Service

Waiver of Further Appearance and Consent to Entry of Judgment

Default forms (Motion and Declaration, Order, Declaration in Support of Judgment,General Judgment)

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STEP 1: STARTING YOUR CASE

Information about Dissolution Keep the court informed of your current address so you get notice of all court dates.

You don’t have to use your home address on any court form. You may useany contact address where you regularly check in, as long as it is in the same state asyour home. The court will assume that you receive all notices sent to that address. Itis YOUR responsibility to let the court know if you move or want to getmail at a different address.

Statutory Restraining Order By filing your Petition, you agree to follow the terms of an automatic restraining order. The order is effective once the papers have been served on the respondent (see below for service information). If you don’t follow the order, you can be held in contempt of court and subject to penalties.

o You must attach a copy of the restraining order (called “Notice of StatutoryRestraining Order Preventing the Dissipation of Assets inDomestic Relations Actions”) to the Summons and serve it on therespondent.

o The statutory restraining order prevents either party from: Dissipating (transferring, selling, destroying, removing, disposing of)

real or personal property. Making changes to insurance policies without the agreement of the other

party. Making extraordinary expenditures (unusual or high-dollar payments or

purchases). Expenditures that are necessary for the safety or welfare ofthe parties, ordinary business activities, or related to this court case areallowed.

STEP 2: FILING AND SERVICE Make copies Keep one copy of all of the completed forms for your records. See below for additional copies you will need.

File your forms

If you eFiled your forms in Guide and File, skip to “Service”, below

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File all of the original forms except the Summons and Notice of Statutory Restraining Order with the court clerk. The clerk will give you a case number when you file. Put the case number on all copies and originals. See below for a list of the forms you will need to copy to serve on the respondent.

You have to pay the filing fees when you file your papers. Go to www.courts.oregon.gov for the filing fee.

• If you are low income, you may ask the court to defer (postpone) or waiveyour filing fee. You must complete an Application and Declarationfor Deferral or Waiver of Fees and an Order Regarding Deferralor Waiver of Fees and file them with your papers. If the fee is deferred,you will have to pay the fee later. If the fee is waived, you don’t have topay it. However, the judge may reconsider waived and deferred fees at theend of the case.

The clerk may give you some papers. A copy of these papers must be included with the Petition that you serve on Respondent (see below regarding service). NOTE: You are not required to serve the List Of Documents Parties May Have To Give Each Other (ORS 107.089) on Respondent, but if you do, then you both have to follow it.

Make a copy of the following forms to serve on the respondent: • Petition• Summons• Notice of CIF Filing• Notice of Statutory Restraining Order Preventing the Dissipation of Assets in

Domestic Relations Actions• Uniform Support Declaration and Statement of Assets and Liabilities (if you are

filing these documents with your Petition) (see Appendices A and C forinformation)

• Any other forms your local court requires you to serve on Respondent

SERVICE

You must officially notify Respondent that you have filed a case. This is called “service.”

Acceptance of Service – If it is safe for you to give the respondent the papers yourself, you will need an Acceptance of Service form. If the respondent signs an Acceptance of Service, no other kind of service is required. Signing the Acceptance of Service does not mean the respondent agrees with anything in your Petition, only that he or she received the papers. You must file the papers with the court before you give the copies to the respondent.

NOTE: Some courts have extra papers you have to serve with your filing.If you eFile your Petition, the court will email you the papers after your filing is accepted. If you do not include these papers with service, your case may be delayed and you may have to pay additional service fees.

(Aug 2019)

http://www.courts.oregon.gov/Pages/fees.aspx

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Formal Service If the respondent does not want to sign the Acceptance of Service, you must use another method. There are four ways you can serve. Service must be done after your Petition is filed.

**3 CRITICAL POINTS**

1. If you serve before you file, you will have to pay to serve the papers again

2. You CANNOT serve the papers yourself

3. If Respondent has a lawyer, you should also send a courtesy copy of the papers to the lawyer

1. Personal Service:a. By Process Server: Take a copy of your papers to the sheriff’s office in the county

where Respondent is located and have a sheriff’s officer serve the papers. Thesheriff’s office charges a fee for service. You can also hire a private process server of your choice.

b. By a Non-Party: Have a competent* person 18 years or older who is a resident ofOregon and who is not a party to the case (Petitioner or Respondent), northe lawyer of a party, serve the papers. The server cannot be an employee of any party. If the respondent is outside of Oregon, the server can be a resident of the state where the respondent is. If you have safety concerns, have the sheriff perform service.

*competent means a person who can understand, remember, and tell others aboutan event.

A Certificate of Service must be filed with the court by whoever serves the respondent. The certificate must include the date of service and the name of the person served.

2. Substituted Service: The process server may leave the papers at therespondent’s residence (where he or she normally lives) with someone 14 or olderwho lives there. The process server must also mail a copy of the papers (with astatement of the date, time, and place that the papers were served) to therespondent by first class mail. Make sure the process server completes aCertificate of Service. The date of service is the day the first class mailing is putin the mail.

3. Office Service: The process server may leave the papers with someone in chargeof the respondent’s office or normal workplace. The process server must also mail acopy of the papers (with a statement of the date, time, and place that the paperswere served) to the respondent by first class mail. Make sure the process servercompletes a Certificate of Service. The date of service is the day the first classmailing is put in the mail.

4. By Mail: First, the process server must send the papers to the respondent’s homeor business address by first class mail. Second, the server must send a copy bycertified mail, return receipt requested. The process server must file proof ofservice with the court, including the signed green card, date of receipt, and itemnumber along with a Certificate of Service. If the green card is not returned or

(Aug 2019)

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if someone other than the respondent signed for it, then service by mail was not effective and you must try another type of service. The date of service is the day the respondent signs the returned green card.

If you are not able to have Respondent served by any of the methods listed above, you may ask a judge to allow you to use another service method. The judge might allow you to publish or post the documents. Forms to make this request are available online at http://www.courts.oregon.gov/forms.

Proof of Service The Certificates are your proof of service. An original Certificate of Service or Acceptance of Service must be filed with the court for your case to proceed, regardless of the method of service.

If proof of service is not received within 63 days of filing your Petition, the court may send you a notice of dismissal. Your case may be dismissed if you do not provide proof of service within 28 days of the notice.

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STEP 3: TEMPORARY ORDERS

You can ask the court to make temporary orders after you file the Petition. Temporary orders are effective as soon as a judge signs the order. They last until a judge changes the terms, signs General Judgment, or dismisses the case. For example, either party may request an order for spousal/partner support, or an order about temporary use of property. To make any of these requests, you must file a “motion” (request) asking the court to do what you want. You may need a lawyer to file these requests.

NOTE: The General Judgment may affect earlier temporary orders done byLimited Judgment. Talk to a lawyer if you have questions.

Go to www.courts.oregon.gov for the forms to request temporary orders. The forms may not cover all temporary orders you need. Talk to a lawyer for more information.

Domestic Violence

All courts have restraining order forms for cases involving domestic violence. A judge will usually hear your request within a day or two of filing. Check with your local court for filing times and procedures.

Refer to www.courts.oregon.gov/fapa for Family Abuse Prevention Act (FAPA) forms and information.

Forms for other types of protective order are available at www.courts.oregon.gov/forms

(Aug 2019)

http://courts.oregon.gov/forms

http://www.courts.oregon.gov/fapa


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STEP 4: RESOLVING YOUR CASE There are three ways your case can be resolved: by agreement between the parties, by default if the respondent doesn’t respond, or by a judge in a hearing.

By Agreement It is always better to resolve issues yourselves, since you know what’s important to you. Once the case goes to a judge, it is out of your control. If you can’t resolve the issues on your own, or if it is not safe for you to talk to Respondent, the court may provide options to help you, including mediation and arbitration. For information about arbitration, see “By Trial” section below.

Mediation: A mediator is a person trained to help people resolve disagreements. Mediation is confidential. You may ask to meet with the mediator alone if you are uncomfortable meeting with the other party for any reason. Check with your local court clerk to see if there is a fee for this service. Mediators are not judges – they cannot impose their decisions on you. Their job is to help you reach an agreement. This may be your last chance to retain control over the outcome of the case. Agreements incorporated into a Judgment are fully enforceable (see below).

Some courts may require that you mediate before you have a hearing. Check your court’s Supplemental Local Rules for more information. If mediation has not yet been ordered in your case and you would like to request it, you may file a Request for Mediation form. If your court requires mediation, you may request that the court waive mediation if you have a good reason by filing a Motion and Declaration for Waiver of Mediation. Talk to your court if you have safety concerns.

If you and Respondent have agreed to all of the issues, fill out and file: • Declaration in Support of Judgment• General Judgment of Dissolution of Marriage/RDP

Note: The Judgment must be signed by both parties before being submitted to the court.

By Default Respondent has 30 days to respond to your Petition. The time starts running from the day after the date of service. The response must be in writing and must be filed with the court and mailed to you. If the respondent does not file a response within 30 days, you may request an Order of Default.

Forms and instructions for getting and Order of Default are included at the end of this document.

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By Trial If Respondent has filed a response and the parties are unable to agree on the terms of a judgment, your case may go to trial

Conferences with the Judge Many courts will schedule a “status,” “pretrial,” or “settlement” conference before a case goes to trial. These meetings usually take place with a judge with both parties present, along with their lawyers (if any). You must attend any conferences that are scheduled unless you have received permission from the judge not to attend. At the conference, the judge may talk to you about how your case is going to be handled, consider requests for temporary orders, or set future court dates.

Some courts may refer certain cases to arbitration. You will receive information from the court if that happens.

Informal Domestic Relations Trials (IDRTs) are available in all courts if both parties agree. See UTCR 8.120 for more information. Each court handles IDRTs differently. Contact your court for more information.

Many courts require that you mediate before you can get a trial. See the BYAGREEMENT section above.

NOTE: You must give the other party an opportunity to review the judgment before you submit it to the court. See UTCR 5.100 for information.

You can represent yourself at trial. Some courts provide information about representing yourself on their websites. Go to www.courts.oregon.gov to find your court’s website.

The State Family Law Advisory Committee has written a guide that may help you prepare for trial. This guide is NOT a substitute for legal advice! The rules of court can be technical and complex. You may damage your case if you are not properly informed. If your case goes to trial, you are strongly advised to talk to a lawyer. To read the guide, go to: http://www.courts.oregon.gov/help/Documents/famlawtrialbrochure.pdf

http://courts.oregon.gov/utcr


http://www.courts.oregon.gov/help/Documents/famlawtrialbrochure.pdf

THE JUDGMENT

Regardless of how you resolve your case, a General Judgment of Dissolution of Marriage/RDP must be signed by a judge. One of you may be ordered to fill out the judgment form and give it to the court to be signed.

The judgment finalizes your dissolution and contains all of the issues decided in mediation, arbitration, trial, or by agreement.

NOTE: The General Judgment may affect earlier temporary orders done by LimitedJudgment. Talk to a lawyer if you have questions.

If the respondent DID NOT file a response, the information you fill out in the judgment should be exactly the same as what you requested in the Petition.

If the respondent DID file a response, the information should be the exactly the same as what was decided in mediation, arbitration, hearing, trial, or through your agreement. All parties must review the Judgment before you submit it to the court. You must send the Judgment document along with the Notice of Proposed Judgment or Order to the respondent and any adult children who have not filed a Waiver of Further Appearance in the case.

Other parties can object to the Judgment. If that happens, you have to discuss the objections and attempt to resolve them before you submit the Judgment to the court. If you are not able to resolve the objections, the objecting parties can either send you a written statement explaining their objections, or they can submit their objections directly to the court. You must complete the Certificate of Readiness section of the Judgment to tell the judge whether there are outstanding objections. See UTCR 5.100(1) for more information about notice and objections.1

If the respondent is responsible for preparing the judgment, the respondent must send the proposed judgment to you before submitting it to the court. Then you can review it and object to it within 7 days of the date it was sent to you. If you and the respondent are not able to resolve your objections after reasonable efforts, you can either send a written explanation of your objections to the respondent or directly to the court. You must notify the respondent of your intentions so that they can advise the judge that there are outstanding issues. The judge may make a decision after reviewing the documents, or the court may contact you with further information.

If you are responsible for preparing the final judgment, make a copy for yourself and one for Respondent (unless you got an Order of Default). File the original with the court.

1 http://courts.oregon.gov/utcr

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http://www.courts.oregon.gov/utcr

http://courts.oregon.gov/utcr

Your dissolution is finished and effective the date the Judgment is signed by the judge. NOTE: the terms of your judgment are not enforceable until the court enters the judgment. You will receive a Notice of Entry of Judgment.

NOTE: Every document you file must have a mailing address or contact address where you will receive documents related to this case. You do NOT need to use your home address. You are responsible for checking your contact address. Notify the court in writing if your contact address changes.

(Aug 2019)

[Attach to Summons per ORS 107.093(5)]

NOTICE OF STATUTORY RESTRAINING ORDER PREVENTING THE DISSIPATION OF ASSETS IN DOMESTIC RELATIONS ACTIONS

TO THE PETITIONER AND RESPONDENT:

Under ORS 107.093 and UTCR 8.080, neither Petitioner nor Respondent may:

Insurance Policies (1) Cancel, modify, terminate, or allow to lapse for nonpayment of premiums, any policy of healthinsurance, homeowner or renter insurance, or automobile insurance that one party maintains to providecoverage for the other party or a minor child of the parties, or any life insurance policy that names eitherof the parties or a minor child of the parties as a beneficiary.

Insurance Beneficiaries (2) Change beneficiaries or covered parties under any policy of health insurance, homeowner or renterinsurance, or automobile insurance that one party maintains to provide coverage for the other party or aminor child of the parties, or any life insurance policy.

Property (3) Transfer, encumber, conceal, or dispose of property in which the other party has an interest, in anymanner, without written consent of the other party or an order of the court, except in the usual course ofbusiness or for necessities of life.

(A) Paragraph (3) does not apply to payment by either party of:(i) Attorney fees in this action;(ii) Real estate and income taxes;(iii) Mental health therapy expenses for either party or a minor child of the parties; or(iv) Expenses necessary to provide for the safety and welfare of a party or a minor child of theparties.

Expenses (4) Make extraordinary expenditures without providing written notice and an accounting of theextraordinary expenditures to the other party. This does not apply to payment of expenses necessary toprovide for the safety and welfare of a party or a minor child of the parties.

EFFECTIVE DATE: The above provisions are in effect immediately upon service of the Petition and Summons on the respondent. They remain in effect until a final judgment is issued, until the petition is dismissed, or until further order of the court.

RIGHT TO REQUEST A HEARING

Either Petitioner or Respondent may request a hearing to modify or revoke one or more terms of this restraining order by filing with the court the Request for Hearing re: Statutory Restraining Order form specified in Form 8.080.2 in the UTCR Appendix of Forms.

REVIEW THIS NOTICE CAREFULLY. BOTH PARTIES MUST OBEY EACH PROVISION OF THIS ORDER TO AVOID VIOLATING THE LAW.

SEE INFORMATION ON YOUR RIGHT TO A HEARING BELOW.

Notice to parties in a suit for marriage dissolution or legal separation regarding continuation of health coverage

If you or your spouse have filed for divorce or legal separation and currently hold group health insurance coverage through your spouse, your coverage may end when the court grants your divorce or separation. Oregon law offers options that may enable you to continue your coverage. This notice outlines continued coverage options available under Oregon law. Federal law commonly known as COBRA may also enable you to continue coverage. Note: You must act promptly to continue coverage.

Applying for individual coverage may also be an option. Insurers can no longer deny enrollment to individuals because of health or pre-existing conditions. You may be eligible to enroll in a plan through healthcare.gov or directly from an insurer. If you apply for coverage through healthcare.gov, you may qualify for financial assistance.

For more information about Oregon and federal law, consult your health insurer, the plan administrator for your insurance coverage, the employer through whom your insurance is provided, or your attorney. The following is a summary of options under Oregon law:

1. Continuation of existing coverage for a divorced or legally separated spouse who is 55 years ofage or older (ORS 743.600 to 743.602). If you are a divorced or legally separated spouse and if you are 55 years ofage or older when the dissolution or legal separation occurs, you may continue your existing group coverage until youobtain other group coverage or become eligible for Medicare. In order to continue coverage, you must do both of thefollowing:

A. You must notify the group health insurance plan administrator in writing of the dissolution or legal separationwithin 60 days of the entry of the decree of divorce or legal separation.

B. You must elect to continue and pay for the group coverage. You must make the election on a form provided by theplan administrator.

Note: This provision applies only if your coverage is provided through an employer who employs 20 or more employees or if your coverage is provided by a group health insurance plan that covers 20 or more employees.

2. Continuation of existing coverage for a divorced spouse when federal law does not provide forcontinued coverage (ORS 743.610). If you are not able to continue your group health coverage under federal law(COBRA), you may continue your existing group coverage upon dissolution of your marriage for a period notexceeding nine months. The following requirements apply:

A. You must have been continuously covered by the group policy for at least three months prior to your divorce.

B. You must ask the insurer or the group policyholder, in writing, to continue your coverage. You must also pay therequired premiums.

C. You must make your request by the latter of the following dates:

(1) Ten days after the date that your coverage under the group policy as a qualified familymember ends;

or

(2) Ten days after the date on which the employer or group policyholder gives notice of the right to continuecoverage.

Department of Consumer and Business Services Insurance Division

P.O. Box 14480, Salem, OR 97309-0405 Phone: 503-947-7891, Fax: 503-378-4351

350 Winter St. NE, Salem, OR 97301-3883 Email: [email protected]

www.insurance.oregon.gov

Page 1 of 2

3. Apply for individual coverage. If you were covered by a group health plan and you lost that coverage becauseof a legal separation or divorce, you may qualify for a special enrollment and be eligible to purchase an individualplan through healthcare.gov or from an insurer. To qualify for this special enrollment:

(1) Apply through healthcare.gov and pay your premium within 60 days of the date you lost your group coverage;

or

(2) Apply for individual coverage from an insurer within 60 days of the date you lost your group coverage.

Remember: The longer you wait to apply, the later your coverage will start. Financial help is available only if you apply for insurance through healthcare.gov. Your insurance agent can also help you apply through healthcare.gov.

Prepared by Insurance Division, Department of Consumer and Business Services, under ORS 107.092. Revised January 9, 2015. Distributed by the Office of the State Court Administrator.

440-3892 (1/15/COM)Page 2 of 2

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF

Case No: ____________________

Petitioner SUMMONS FOR FAMILY LAW and CASE

Marriage Registered Domestic

Partnership (RDP) Respondent Unmarried & Unregistered

To (name):

Address:

Your spouse or partner has filed a Petition asking for divorce or dissolution of your marriage or registered domestic partnership (RDP).

You must “appear” in this case or the other side will win automatically. To “appear,” you must file a legal paper called a “Response” or a motion. Response forms are available through the court at the address above or online at www.courts.oregon.gov. Talk to a lawyer for information about appearing by motion.

Your Response must be filed with the court clerk at the court listed above within 30 days of the day you received this Summons, along with the required filing fee (go to www.courts.oregon.gov for fee information). It must be in proper form and you must show that the Petitioner’s lawyer (or the Petitioner if he or she does not have a lawyer) was formally served with a copy of the Response according to the service rules. Service rules are included in Instructions for Respondents, available at www.courts.oregon.gov.

If you have questions, see a lawyer immediately. If you need help finding a lawyer, you can call the Oregon State Bar’s Lawyer Referral Service at 503.684.3763 or toll free in Oregon at 800.452.7636, or go to www.oregonstatebar.org.

Date Petitioner Signature

Name (printed)

Contact Address City, State, ZIP Contact Phone

NOTICE TO RESPONDENT: READ THESE PAPERS CAREFULLY!




http://www.oregonstatebar.org/


Case No: _________________ Petitioner

and ACCEPTANCE OF SERVICE

Respondent

I am the Respondent in this case

On (date) I received a true copy of (check all that apply):

Petition Summons Information on mediation Notice of Statutory Restraining Order Preventing Dissipation of Assets Notice of CIF (Confidential Information Form) Filing Information on continuation of insurance coverage (COBRA) Statement of Assets and Liabilities Uniform Support Declaration Other forms:

I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use in court and I am subject to penalty for perjury.

Date Signature

Name (printed)

Address City/State/Zip Telephone

(Aug 2019)


Case No: ____________________

CERTIFICATE OF SERVICE Petitioner (ORCP 7D(2))

and □ (a) Personal Service□ (b) Substitute Service□ (c) Office Service

Respondent □ (d) Service by Mail

I, (name) , declare that I am a resident of the state of . I am a competent person 18 years of age or older. I am not a

party to or lawyer in this case, and not the employee of a party. I certify that the person served is the person named below. I served true copies of the original (check all that apply):

Petition and Summons Information about mediation Notice of Confidential Information Form (CIF) Filing Notice of Statutory Restraining Order Preventing Dissipation of Assets Order to Show Cause re: Modification with Motion and Declaration Information about continuing insurance coverage (COBRA) Uniform Support Declaration Other (name all forms or documents served)

by (check a, b, c, or d and complete all information): (a) □ Personal Service on (date) , at a.m./p.m., to

{□ Petitioner □ Respondent} (name) in person at the following address in the County of , State of .

(b) □ Substitute Service on (date) , at a.m./p.m., bydelivering them to the following address in the County of , State of . Delivered to (name)

, who is a person age 14 or older and who lives there. (Complete the section below only if the server also did the follow-up mailing required by ORCP 7D(2)(b). If a person other than the server did the follow-up mailing, that person must complete a separate Certificate of Service Mailing.)

□ On (date) , I personally deposited a true copy of the same documents served with the U.S. Postal Service, via first class mail, in a sealed envelope, postage paid, addressed to the party to be served: □ Petitioner □ Respondent (name)

, at the party’s home address listed above, together with a statement of the date, time and place that the documents were hand-delivered to the party’s dwelling (residence).

(c) □ Office Service on (date) , at a.m./p.m., by delivering them to the office of the party to be served, located at: (address)

, during normal working hours for that office, where I left the documents with (name) , who is a person apparently in charge, to give the documents to the party to be served. (Complete the section below only if the server also did the follow-up mailing required by ORCP 7D(2)(c). If a person other than the server did the follow-up mailing, that person must complete a separate Certificate of Service Mailing.)

□ On (date) , I personally deposited a true copy of the same documents served with the U.S. Postal Service, via first class mail, in a sealed envelope, postage paid, addressed to the party to be served: □ Petitioner □ Respondent (name)

, at the party’s: □ home address at: , OR business address above, together with a statement

of the date, time and place that the documents were hand-delivered to the party’s office.

(d) □ Service by Mail, Return Receipt Requested on (date) , I personally deposited two true copies with the U.S. Postal Service. One by first class mail, and the other by certified or registered mail, Return Receipt Requested, or by express mail, postage paid, addressed to the party to be served: □ Petitioner □ Respondent

(name), at the party’s home address located at: (address). (NOTE: If mailed Return Receipt

Requested, the return receipt must be attached to this Certificate of Service.)

I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury.

Date Signature of Server

Print Name

If person serving is NOT a sheriff or sheriff’s deputy, address and phone number of server:

(Aug 2019)


Case No: _________________

Petitioner WAIVER OF FURTHERand APPEARANCE AND CONSENT

TO ENTRY OF JUDGMENT

Respondent

I am the respondent in this case. I waive (give up) my right to further appearance and consent (agree) to entry of judgment according to the terms of the Petition.

I hereby declare that the above statements are true and complete to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury.

Date Signature

Print Name

Contact Address City, State, Zip Contact Phone

(Aug 2019)

(Aug 2019)

Statement of Assets and Liabilities

You will need to file a Statement of Assets and Liabilities if the respondent files a Response and you have not reached an agreement as your trial date nears. Each party’s Statement must be filed with the court and served on the other party at least 14 days before your trial. Check your local court’s Supplementary Local Rules, Chapter 8 for other time limits and requirements. Give or mail a copy to the other party and complete the Certificate of Service at the end of the form before filing with the court.

Most courts prefer that you complete ONE joint form so that you don’t have one form listing “house 1” and the other calling it “123 Main St.” Your Statement should name the asset as specifically as possible. You and the other party should do everything you can to agree on the value of your assets and liabilities. Then list who the court should give each asset or liability to. You can use one of the formats below. NOTE: if there is a restraining order, protective order, or no-contact order between you and the other party, submit separate forms.

Tax debts, student loans, and support arrears can be totaled for each party, details are not required.

In the examples below, the parties disagree about the value of the Ford Ranger but agree that it should be awarded to Petitioner. The parties agree about the value of the Kia Soul but disagree about who it should be awarded to. Leave the last 2 columns blank – the judge will make a final decision about the value of each asset and who it is awarded to.

www.courts.oregon.gov/slr

Statement of Assets and Liabilities Case # Submitted by: (name) Petitioner Respondent

DESCRIPTION

OF ASSETS

PETITIONER Name:

RESPONDENT Name:

COURT

Claimed Value Proposed

Distribution (Pet or Resp)



Value Distribution (Pet or Resp)

1. Real Proper ty(address)

2. Vehicles (car, truck,boat, ATV, etc.)

3. Bank Accounts (bank,type, & name on theaccount)

4. Cash on Hand

5. Furniture/Appliances

6. Personal Proper ty(by type)

7. Business Interests






8. Insurance Policies (with cash surrender orloan value)

9. Pensions andInvestments

10. Expected Assets (inheritance, tax refund, pending lawsuit)

11. Other assets

TOTAL ASSETS: Additional page attached

DESCRIPTION

OF LIABILITIES PETITIONER RESPONDENT COURT



Claimed Value Proposed Distribution (Pet or Resp)


12. Mor tgages

13. Vehicle loans

14. Tax Debt

15. Student Loans



Claimed Value Proposed Distribution (Pet or Resp)


16. Credit Card Debt

17. Suppor t Ar rears

18. Cour t Fines

19. ExpectedLiabilities (college costs, pending lawsuit)

20. Other Debt/Loans

TOTAL LIABILITIES:

Additional page attached

USE THIS PAGE FOR ADDITIONAL ASSETS & LIABILITIES NOT LISTED ABOVE

DESCRIPTION

PETITIONER RESPONDENT COURT Claimed Value (mark “ +” for

assets and “ -“ for liabilities)

Proposed Distribution (Pet or Resp)

Claimed Value (mark “ +” for

assets and “ -“ for liabilities)

Proposed Distribution (Pet or Resp)


TOTAL ADDDITIONAL ASSETS: TOTAL ADDITIONAL LIABILITIES:

If Respondent Does Not Respond:

The respondent has 30 days to respond to your Petition. The time starts running from the day after the date of service. The response must be in writing and must be filed with the court and mailed to you. If the respondent does not file a response within 30 days of the date of service, you can request an Order of Default.

Default Default means that you are asking the judge to award you what you asked for in your Petition because the respondent did not file a response. Look at Oregon Rules of Civil Procedure (ORCP) rule 69 for more detailed information. NOTE: If the respondent has given you written notice that he or she intends to appear,

you have to give written notice that you intend to apply for a default order at least 10days before you file your motion. See Uniform Trial Court Rule 2.010 for the form yournotice must be in. File your notice of intent with the court and serve it on the respondent.See Oregon Rules of Civil Procedure Rule 9 for information about how to servedocuments after the Petition.

The judge may not grant a default if the respondent is incapacitated, a minor, a financially incapable person, a protected person, or a respondent in a fiduciary protective proceeding, as defined by ORS 125.005.

You must also show that the respondent is not in active military service before the court can enter an order of default. This is part of the Ex Parte Motion for Order of Default & Declaration in Support. If the respondent is in active military service, you cannot get an order of default unless the servicemember waives protection under the Servicemembers Civil Relief Act (SCRA). This federal law starts at 50 U.S.C. 3901. Your local law librarian can help you find it, or go to www.law.cornell.edu* (under Get the Law click U.S.Code, then click Title 50 and go to Chapter 50). This law has strict rules about what “active military service” means. This protection does not apply to all servicemembers at all times.

If the respondent is in the military, you should see a lawyer before trying to get an order of default. If a default is not done properly, the respondent can re-open the case after returning from service. Be aware that if you knowingly make false statements about the respondent’s status, you may face both federal and state penalties.

If you know the respondent is not in the military, you must state facts that explain how you know.

If you have the respondent’s Social Security Number or date of birth, go to the Department of Defense website (https://scra.dmdc.osd.mil/) to find out if the respondent is in active service. This site can give you a free statement of service status that you can print out (called a “certificate of service” on the website). Attach this statement or a printout of the screen

* This is an outside site maintained by Cornell University. The Oregon Judicial Department is not responsible forany information on this site. Links may have moved.

https://www.oregonlegislature.gov/bills_laws/Pages/orcp.aspx

www.courts.oregon.gov/utcr

https://www.oregonlegislature.gov/bills_laws/Pages/orcp.aspx

https://www.oregonlegislature.gov/bills_laws/ors/ors125.html

http://www.law.cornell.edu/

https://scra.dmdc.osd.mil/

to your motion. You can also call 571.372.1100 for military verification. Put the date and the name of the person you spoke with on your motion. If you don’t have the Social Security Number or date of birth, commercial sites may be able to provide information.

If you don’t know whether the respondent is in the military and have checked the website, or don’t have the necessary information, mark “I am unable to determine whether this person is in military service” and add any facts that you do know. The judge will decide whether to grant the default.

If Respondent is in the militaryIf the respondent is in active military service of the United States and has not responded to thePetition, the court won’t go ahead with your case until one of the following things happens:

(1) Respondent is no longer in active military service,(2) Respondent waives, in writing, the right to avoid default, or(3) the judge holds a special hearing in your case.

Talk to a lawyer if the respondent will not sign the waiver and you do not want to wait for military service to end. The SCRA rules are technical and complex. Contact the Oregon State Bar for help (contact information is on Page 1). The court does not provide blank waivers for this purpose.

* * * * *Requesting a Default - fill out the following forms (included below):

• Ex Parte Motion for Order of Default and Declaration in Support• Order on Motion for Default• Declaration in Support of Judgment• General Judgment of Dissolution of Marriage/RDP

Read your Petition CAREFULLY! The Declaration in Support of Judgment allows you to note any information that has changed since you filed the Petition. Read each section of the Petition you filed and note any changes in the spaces provided. You must complete the rest of the Declaration in all cases. Guide & File has completed some information for you, but you need to check all of the information to make sure it is complete and nothing has changed.

The Judgment Guide & File has pre-completed most of the General Judgment form. It is VERY important that you check ALL of the information! Some information cannot be completed by the system. If you leave required fields blank or do not correct inaccurate or changed entries, your judgment may be delayed or returned to you.

After you make yourself a copy of the completed forms, file the originals with the court any time after 30 days from the date of service. You must file the Motion for Order of Default by the 91st day after you filed the Petition (NOT the proof of service!). If not, your case may be dismissed.

The court will send you notice when your judgment has been entered.

Page 1 of 2


Case No: ______________________ Petitioner

and EX PARTE MOTION FOR ORDER OF DEFAULT and

DECLARATION IN SUPPORT Respondent

Motion Based on the attached Declaration, Petitioner requests that this court grant an Order entering the default of Respondent and directing entry of judgment.

Statement of Points and Authorities ORCP 69 requires the court or clerk to enter an order of default on a showing by affidavit or declaration that a party against whom a judgment is sought has been served with Summons or is otherwise subject to the jurisdiction of the Court and has failed to plead or otherwise defend within the time set by law.

Declaration

Respondent was served with the Summons, Petition and other documents required by law in County, State of , on (date) and

has not made an appearance within the time required by law.

Respondent has not provided me with written notice of intent to appear. or

Respondent provided me with written notice of intent to appear and I filed and served written notice of intent to apply for default at least 10 days before filing this motion, or fewer days as permitted by the court.

Respondent is not now, and was not at the time of the service of the Petition and Summons, incapacitated, a minor, a financially incapable person, a protected person, or a Respondent in a fiduciary protective proceeding, as defined by ORS 125.005,

and (check one of the following): □ The Respondent is not now, and was not at the time of service of the Petition andSummons, in active military service of the United States. Provide facts supporting thisstatement:

□ The Respondent is now, or was at the time of service of the Petition and Summons, inactive military service of the United States. Respondent has waived his or her rightsunder the Servicemembers’ Civil Relief Act, as shown by the attached waiver, labeledExhibit .

(Aug 2019)

Page 2 of 2

□ I am unable to determine whether or not Respondent is now, or was at the time of theservice of the Petition and Summons, in active military service of the United States.Provide any facts you do know:

I request the relief specified in the attached Judgment.

Costs and fees are allowable under ORS 107.105(1)(j) or 107.490(4).

I hereby declare that the above statements are true to the best of my knowledge and belief, and that I understand they are made for use as evidence in court and I am subject to penalty for perjury.

Date Signature

Name (printed)

Contact Address City, State, ZIP Contact Phone

(Aug 2019)

Page 1 of 1



and ORDER ON MOTION FOR DEFAULT

Respondent

Based on the motion and declaration of the Petitioner in this case,

The court DENIES the Ex Parte Motion for Order of Default because: the respondent was not properly served with the Petition and Summons or other

necessary documents, or no proof of service has been filed with the court. the respondent has filed an appearance. the respondent is now or was, at the time of service of the Petition and Summons, in

active military service of the United States and has not waived protection under the Servicemembers Civil Relief Act.

the respondent is now, or was, at the time of service of the Petition and Summons, incapacitated, a minor, a financially incapable person, a protected person, or a Respondent in a fiduciary protective proceeding, as defined by ORS 125.005.

Other:

The court GRANTS the Ex Parte Motion for Order of Default and directs entry of judgment because the court finds that:

1) The respondent was properly served with the Petition and other necessary documentsand has not filed an appearance,

2) The respondent is not now and was not, at the time of service of the Petition andSummons, incapacitated, a minor, a financially incapable person, a protected person, ora Respondent in a fiduciary protective proceeding, as defined by ORS 125.005, and

3) The respondent: is not now and was not, at the time of service of the Petition and Summons, in active

military service of the United States, or is in active military service of the United States and has waived protection against

default judgments under the Servicemembers Civil Relief Act.

Judge Signature:

Declaration in Support of Judgment Page 1 of 1


In the Matter of the Marriage or Registered Domestic Partnership (RDP) of:


and DECLARATION SUPPORTING GENERAL

JUDGMENT OF DISSOLUTION OF MARRIAGE RDP

Respondent

The statements made in the Petition remain true and accurate except:

Section Number Explain

Additional page attached

□Petitioner □ Respondent is pregnant (and) the other party □ is □ is not the parent of thischild. The expected date of the child’s birth is

I ask the court to enter judgment without a hearing under ORS 107.095(4) because: Respondent has not appeared and an Order of Default has been entered Respondent has stipulated (agreed) to the terms of the Judgment

I hereby declare that the above statements are true and complete to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury.

Submitted by Petitioner Respondent

Date Signature

Name (printed)

Contact Address City, State, Zip Contact Phone

(Aug 2019)

NOTICE OF PROPOSED JUDGMENT OR ORDER To be sent to all other parties before submitting proposed Judgment or Order to the court for signature. Send the Judgment or Order to the other party with this Notice at least 7 days before submitting it to the court. This does not apply to judgments submitted with a Motion for Order of Default or after an Order of Default has been granted.

This notice is to inform you that you can object to the attached proposed Judgment or Order.

Uniform Trial Court Rule (UTCR) 5.1001 allows you to object to the proposed judgment or order. If you have no objections, you can sign the last page and return it to me.

If you do object to any of the terms of the judgment or order, you may:

1) Contact me within 7 days of the date of this notice. If you contact me and weare not able to resolve your objections after reasonable efforts, I will include your objections with the proposed judgment or order when I submit it to the court.

or

2) Submit your objections directly to the court. If you intend to submit yourobjections directly to the court, notify me within 7 days of the date of this notice so that I can inform the court of your intentions when I submit the proposed judgment or order. If you do object to the proposed order or judgment, you must contact me within 7 days of the date of this notice.

Date Signature

Name (printed)

Address City/State/Zip Phone

1 www.courts.oregon.gov/utcr

www.courts.oregon.gov/utcr

Judgment – Dissolution Page 1 of 8 (Aug 2019)


In the Matter of the Marriage or Registered Domestic Partnership (RDP) of:

Case No: ___________________

Petitioner GENERAL JUDGMENT OF and DISSOLUTION OF MARRIAGE RDP

Respondent This document was presented to the court: □ On the motion and declaration of Petitioner, the default of Respondent having been found.

□ and Respondent being represented by a guardian ad litem or other person described in Oregon Rules of Civil Procedure, Rule 27

□ On the stipulation of the parties, as shown by the signatures at the end of this Judgment □ After a hearing held (date), at which the following persons were present: □ Petitioner □ Petitioner’s attorney □ Respondent □ Respondent’s attorney □ Other

FINDINGS: A. The court considered the □ Declaration □ Stipulations □ Evidence presented and finds

that: I. Irreconcilable differences have caused the irremediable breakdown of this marriage or

domestic partnership

II. At the time the Petition was filed: Marriage Only: □ At least one spouse lived in Oregon and that same spouse had lived

in Oregon continuously for 6 months prior to the filing of the Petition. At least one spouse lived in the county in which the Petition was filed.

Registered Domestic Partnership Only:

□ At least one partner lived in Oregon and that same partner had lived in Oregon continuously for 6 months prior to the filing of the Petition. At least one partner lived in the county in which the Petition was filed.

or □ neither partner lived in Oregon and the Petition was filed in the county where {□ Petitioner □ Respondent} last resided

III. The parties have no children together under the age of 21

B. Party and Marriage/RDP Information:

Date of Marriage or registration of RDP:

Place of Marriage or registration of RDP: (County, State)


Current age of parties: Petitioner Respondent

C. Pregnancy□ Neither party is now pregnant (or)□ Petitioner □ Respondent is now pregnant.

The other party is is not the parent of the child due (date)

The marriage or RDP is legally dissolved as of the date this Judgment is signed. The terms of this judgment are effective upon entry in the court register.

SPOUSAL/PARTNER SUPPORT There is an existing Limited Judgment for temporary spousal/partner support. Temporary

support under the limited judgment ends as of the date of entry of the General Judgment, but any arrears accrued under the Limited Judgment remain enforceable under the Limited Judgment.

1. Spousal or Partner Support No spousal/partner support or life insurance for the benefit of either party is ordered in

this case or Spousal support must be paid by □ Petitioner to Respondent (or) □ Respondent to

Petitioner

Type of Support: Payment Terms:* Based on these factors:

Transitional

_________

monthly payments beginning the month following: entry of this judgment or the date of service of this Petition or ______________________ Ending*:

Or lump sum payable by (date): _____________

Compensatory

_________



Maintenance

_________




*All monthly payments are due by the 1st of the month. All payments end on the death of either party (unless an earlier event is specified above)

All payments of spousal/partner support must be made: □ Directly into ’s bank account. The paying

spouse/partner should keep a receipt of deposit as proof of payment. The person receiving support must provide the person paying support with current deposit slips or bank name, account name, and account number. or

□ To the Department of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309. Petitioner requests that collection, accounting, and disbursement services be provided through the Department of Justice. (NOTE: services are only available through DOJ if the receiving party is on public assistance or if your county provides services locally. DOJ will notify you if your case does not qualify for services. Talk to a lawyer for more information)

2. Withholding

If enforcement services are provided through the State of Oregon’s Department of Justice, the support order is enforceable by income withholding under ORS 25.311

3. Life Insurance

The party paying support must carry life insurance for the benefit of the other party throughout the period of the support obligation if he or she is insurable. The coverage must be at least $ . The party paying support must provide to the party receiving support a true copy of the policy. The party paying support must also provide to the party receiving support written notice of any action that will reduce the benefits or change the designation of the beneficiaries under the policy. or

Neither party is ordered to carry life insurance for the benefit of the other party PROPERTY AND DEBTS 4. Real Property

Neither party has any interest in any real property in Oregon or any other place Both parties have or {□ Petitioner □ Respondent} has an interest in real property

at: (address) □ This property is awarded as follows: □ Additional page attached

□ The legal description of the property is attached as Exhibit and incorporated into this Judgment □ Petitioner □ Respondent is responsible for preparing, signing, and recording a deed transferring the real property as required by this judgment Other:

5. Personal Property The Petitioner and Respondent have divided between them all personal property that they own separately or together, and each is awarded those items now in their possession

except that:


A. □ The Petitioner is awarded the following personal property:

□ The Petitioner is awarded all retirement benefits, pension plans, profit-sharing plans, deferred compensation plans, and stock options held by Petitioner’s current and past employers, free of any interest by the Respondent

B. □ The Respondent is awarded the following personal property:

□ Additional page attached titled “Section 5B-Respondent’s Personal Property”

□ The Respondent is awarded all retirement benefits, pension plans, profit-sharing plans, deferred compensation plans, and stock options held by Respondent’s current and past employers, free of any interest by the Petitioner

6. Distribution of Debts The debts will be paid as follows:

Name of creditor (who money is owed to)

What the debt is for Amount Who pays (Petitioner or Respondent)

□ Additional page attached titled “Section 6-Distribution of Debts”

Unless otherwise specified above, each party is responsible for the payment of all debts incurred by him or her individually since the date of separation, all debts distributed to him or her by the court, and all debts which are secured by property distributed to that party. If any creditor asks the party not responsible for a debt to pay any portion of it, and he or she does so, the party responsible for that debt must reimburse the paying party for any amount paid to the creditor after the date this judgment is entered. Debts are divided between the parties as of (date): 7. Transfer of Property and Debts

Within thirty (30) days of the date of this judgment, each party must execute, acknowledge, and deliver whatever documents are necessary to accomplish the distribution of debts and property ordered by the court. This judgment operates to convey title to the party awarded the property if the other party fails to comply with this requirement.

8. Former Name □ Petitioner’s □ Respondent’s former name of is restored


9. 9. Additional Provisions:

□ Additional page attached titled “Section 9 - Additional Provisions”

10. Court Costs and Fees, Whether Paid Or Deferred Each party is responsible for paying his or her own court costs and service fees Petitioner Respondent will reimburse the other party $ for

costs and fees Judgment is awarded to the State of Oregon for deferred costs or fees of $ Other:

11. Information Required by ORS 25.020 and 107.085As required by UTCR 2.130, a Confidential Information Form has been completed for eachparty and filed with the court. The CIF contains all information required by ORS 25.020 and107.085 that is identified as confidential by UTCR 2.130.

Both parties must inform the Court and the Department of Justice (P.O. Box 14506, Salem, Oregon 97309) in writing of any change in the information within ten (10) days of such change. The Department of Justice or the District Attorney shall not disclose the information in the CIF to the other party.

Money Award Support Obligation □ included □ not included

PETITIONER RESPONDENT

Full Name

Contact Address

Year of Birth

Social Security # (last 4 digits)

Driver License # (last 4 digits) and State

Lawyer Name, Address, Phone #

NOTE: a party RECEIVING a money award is the JUDGMENT CREDITOR; a party PAYING a money award is the JUDGMENT DEBTOR

The following information must be provided by any party entitled to receive a money award as listed in this Judgment


The following person or public body is known to be entitled to a portion of a payment made on the judgment (other than payee’s lawyer):

Petitioner None or Name: ______________________________ ______________________________________________

Respondent None or Name: ______________________________ ______________________________________________

Type of Judgment

Amount Beginning / Ending

Spousal/ Partner Support

WHO RECEIVES □ Petitioner□ Respondent

Transitional _________

per month or

total

Payable on the first of every month beginning the month following:

entry of this judgment or the date of service of this Petition

or: ________________ Ending:

or due in full by: (date): _____________ Other:

Compensatory _________

per month or

total


entry of this judgment or the date of service of this

Petition or: ________________

Ending:


Maintenance _________

per month or

total


entry of this judgment or the date of service of this Petition

or: ________________ Ending:


All payments end on the death of either party unless an earlier event is specified


Type of Judgment

Amount Beginning / Ending

Property Division

WHO RECEIVES □ Petitioner □ Respondent

$ ___ per month until a total of $ is paid

Beginning the (day) __ of the month following entry of judgment

or A lump sum of

$ Paid by (date):

Prejudgment Interest


$ ___

Postjudgment Interest


9% per year simple interest on the unpaid balance of the total judgment amount of

$

Interest accrues from the date the judgment is entered and continues until fully paid.

□ Court Costs and Service Fees already

paid

WHO PAYS □ Petitioner □ Respondent

Checked party reimburses the other party’s costs and fees of: $ Directly to the awarded party

□ Deferred Court Costs and Service

Fees

WHO PAYS □ Petitioner □ Respondent

Checked party must pay deferred costs and fees of:

$___________________

To the State of Oregon through this court Judge Signature: Certificate of Readiness This proposed judgment is ready for judicial signature because (check all that apply):

Service is not required under UTCR 5.100. The other party has been found in default or an order of default is being requested with this proposed judgment; this judgment is submitted ex parte as allowed by statute or rule; or this judgment is being submitted in open court with all parties present.


Each party affected by this judgment has stipulated to or approved the judgment, as shown by

the signatures on the judgment.

I have served a copy of this judgment and written notice of the 7-day objection period set out in UTCR 5.100 on all parties entitled to service (complete service information below). And:

No objection has been served on me within that time frame. I received objections that I could not resolve with the other party despite reasonable efforts

to do so. I have filed with the court a copy of the objections I received and indicated which objections remain unresolved.

After conferring about objections, the other party agreed to file any remaining objection with the court.

Certificate of Service under UTCR 5.100

I certify that on (date): I placed a true and complete copy of

this proposed Judgment in the United States mail to (name)

at (address)

Submitted by: Petitioner Respondent Signature Print Name

I understand that I am subject to penalty for perjury for giving false information to the court. All factual information in this Judgment is true to the best of my knowledge and belief. I agree to the terms of this Judgment. I understand that this Judgment is enforceable by the court. Petitioner, Signature Date Petitioner, Name (printed)

Respondent stipulates (agrees) to the terms of this judgment Respondent, Signature Date Respondent, Name (printed) Contact Address City, State, Zip Contact Phone